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NPI Code Detail

MEDICARE: ADVANCED BEHAVIORAL HEALTH SERVICES, LLC

MEDICARE: ADVANCED BEHAVIORAL HEALTH SERVICES, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251S00000XCommunity/Behavioral Health Agency0810004544VA

General Provider Information

NPI Number : 1780923292
Entity Type Code : Organization
Provider Name (Legal Business Name) : ADVANCED BEHAVIORAL HEALTH SERVICES, LLC
Provider Business Mailing Address
First Line : 7514 VAN HOY DR
Second Line :
City : NORTH CHESTERFIELD
State : VA
Zip : 23235-6454
Country : US
Telephone Number : 804-539-2557
Fax Number :
Provider Business Practice Location Address
First Line : 1241 MALL DR
Second Line :
City : NORTH CHESTERFIELD
State : VA
Zip : 23235-4879
Country : US
Telephone Number : 804-539-2557
Fax Number :
Authorized Official
Title or Position : CEO- CLINICAL PSYCHOLOGIST
Name : DR. ALAN THOMAS VON KLEISS
Credential : PSYD
Telephone Number : 804-539-2557
Provider Enumeration Date : 02/04/2013
Last Update Date : 02/04/2013

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Directions to “ADVANCED BEHAVIORAL HEALTH SERVICES, LLC ” Practice Location

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